Provider Demographics
NPI:1407225170
Name:MIDDLE PLACE LEARNING AND INFORMATION STATION
Entity Type:Organization
Organization Name:MIDDLE PLACE LEARNING AND INFORMATION STATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:CAM
Authorized Official - Last Name:NIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-368-0038
Mailing Address - Street 1:1949 MIDDLE PLACE RD
Mailing Address - Street 2:
Mailing Address - City:OLAR
Mailing Address - State:SC
Mailing Address - Zip Code:29843-3462
Mailing Address - Country:US
Mailing Address - Phone:803-368-0038
Mailing Address - Fax:803-245-5665
Practice Address - Street 1:1949 MIDDLE PLACE RD
Practice Address - Street 2:
Practice Address - City:OLAR
Practice Address - State:SC
Practice Address - Zip Code:29843-3462
Practice Address - Country:US
Practice Address - Phone:803-368-0038
Practice Address - Fax:803-245-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health